I have had an enlarged prostate (BPH) since my ‘ 40’s and am now 67. In attempts to solve my prostate problems, I ended up having both a TUMT (transurethral microwave therapy) and laser treatment (Green Light XPS laser). I also went through various other procedures, used a range of medications and at one stage almost died through blood loss. BPH affects millions but there are still lots of unknowns and everyone’s experience is different. So here is my story. It purposely includes lots of detail, which may be of help to some readers. Your comments and questions are welcomed in the “Comments” box below.
Since my 30?s, I have always needed to be aware of where the bathrooms were wherever I went, because I needed to go every couple of hours during the day and generally got up a couple of times a night. It didn’t seem like such a big deal to me so I just coped with it. My PSA tests always hovered just below the acceptable limit for my age. My PSA is now 6.5, but I have had readings as high as 8.9. I’ve never had a biopsy. I assumed a slow moving psa score was a good thing, and it was probably best to leave it alone. I gave myself a PSA limit of 10 before I planned to take further action.
Three years ago, I fell hard on my butt on the ice while shovelling my driveway and shortly thereafter started to experience a restricted flow. I tried over the counter remedies that seemed to help for a few weeks, and then the condition got worse. When I was unable to pee I had to rush into ER where the nurse inserted a catheter. I had 1400ml of urine. For a person who generally never had more than 300 ml before voiding, this was pure torture.
I contacted a urologist (who I still go to) and after a range of tests, I was diagnosed with enlarged prostate. He prescribed flomax (tamsulosin) which worked within a couple of days and continued to work. It did give side effects though, and I estimate it caused a loss of about 30% of my muscle strength and it left my sinuses very stuffed. However, I was more than happy to take a pill despite the side effects. My urologist did not like tamsulosin as a long-term solution, and said I would need a procedure.
After about 3 months, just as the tamsulosin side effects started to disappear, the drug stopped working for me. My urologist advised a minimally invasive treatment called TUMT (transurethral microwave therapy), which is to insert a microwave heating element into the penis and up to the prostate, and heat the prostate tissue to about 50 degrees C for about 40 minutes. The theory is that it cooks a bit of the prostate canal, which then sloughs off, leaving a wider and a bit more rigid channel to improve the urine stream. I had the TUMT in April 2011, and after about 8 weeks of quite painful recuperation things were going well. But after eight or nine months the symptoms were very bad again. The TUMT gave me two months of painful recuperation and six months of relief.
Once again, I was having frequent burning urination of small amounts of urine. My time between bathroom visits was about 45 minutes during the day and I was getting up seven or eight times a night. My urologist recommended the Green Light XPS laser. (As an aside, the technician who performed the TUMT procedure on me candidly had told me the TUMT would not last and I would need laser treatment. The technician was exactly right.)
While waiting to be scheduled for the laser treatment (and getting all the tests, including a Cat Scan and Ultrasound, blood work, etc.) I was back on tamsulosin for three months, and like before, it stopped working, so in the spring 2012, about one year after the TUMT, I had the Green Light laser.
The ultrasound showed I had an enormous prostate at about 10cm x 9cm x 8cm which I figured was the size of large orange. I also had a large median lobe about 4cm cubed protruding into my bladder. My urologist administered the 180 watt XPS GL laser and in 70 minutes, using up two tips, removed about 70grams of prostate tissue. His estimate was that my prostate had been at least 120g. He was not able to remove much of the median lobe because he didn’t want to risk puncturing the bladder. Since the median lobe wasn’t blocking the bladder we agreed to let it alone for then.
Once again, I had a painful and difficult 8 weeks of recovery. By the ninth week, the bleeding had become very light and the extreme bladder spasms I had been experiencing at the end of my urinations (eye-popping pain that lasted about 10 – 20 seconds) finally eased up. Also during the eight-week recuperation, my urgency was very bad. When I felt the urge to go I literally had about five seconds or less to get to a bathroom or start peeing my pants. Luckily, because I am retired, I was able to stay at home.
About six months after the Green Light Laser, at the beginning of 2013, my stream became noticeably constricted. My urologist checked it out with a cystoscope and found a 1.5 cm piece of tissue was blocking my sphincter. He immediately suggested another laser treatment, which I wasn’t eager to try.
Another option he gave me was to self catheterize once every two weeks “to keep the channel open”. I had learned to self catheterize and had done it about a dozen times when I was in complete retention (this was a lot better than driving to ER) so I was willing to do that.
I self catheterized every two weeks or so during 2013. I had worked my way up to a size 16FR single use hydrophilic catheter every two weeks, which seemed liked a small inconvenience. It also allowed me to catheter into a urinal with ml markings on it to measure my own PVR (post void residual) which varied from 25 ml to 200 ml, generally averaging about 125 ml., which my urologist thought was fine.
In December 2013 I got some sporadic bleeding about a week after my catheter. I had a Friday appointment and wasn’t too concerned. I had seen a lot of blood urine during my recuperation’s. One void would be bloody and the next would be clear. The bleeding started on a Tuesday, but Thursday night the consistency of the blood changed from burgundy wine to a thick spaghetti sauce. I was also seeing small purplish clots. When I peed in a cup to get a better look at it, the blood coagulated into a pudding within a few seconds. It appeared this was hemorrhaging fresh blood, not urine, which it was.
We drove to the ER and they inserted a three way irrigation Foley catheter to wash out the clots and sent me home a few hours later after I had stopped bleeding, knowing I was due to see my urologist the next day. About an hour after I got home I realized my catheter was blocked. I pulled it out and found it was filled with the coagulated tomato sauce again. My wife called for an ambulance and I got in a hot shower where I pulled out, cleaned out and reinserted the catheter about a dozen times. When we got to ER again they started the irrigating three way catheter which I was on for the next three days.
Unbeknown to anyone (until I passed out!), the irrigation had washed away my continual blood flow and my hemoglobin had dropped from 15 to 6. Luckily, my GP was on hospital rounds that Sunday and dropped into to see me just as I had passed out. That day I had felt like I was in a dream state and finally I just keeled over. Eventually I felt my wife slapping me on the face and yelling at me, and then I found myself on a crash cart. This development convinced my urologist the irrigation wasn’t stemming the bleeding and scheduled emergency surgery the next morning.
That night I was given three pints of whole blood, and in the three days following the surgery I was given five more pints of whole blood for a total of eight. Given the body only has about twelve pints of blood I got the feeling I may have been close to bleeding out. During the surgery, my urologist found 3 bleeders on my prostate, urethra and bladder neck, which he cauterized. My bladder was still caked with blood clots, which he washed out, and did a resection of my bladder neck to make a clean, wider, opening. He also found “a bunch of bladder stones the size of bb’s” which he crushed and removed.” I left the hospital seven days after I entered at the end of Dec. 2013.
It has been a little more than six months since my surgery and I have a decent stream. I go to the bathroom about every two to three hours around the clock, which is what I was doing thirty years ago. I have been taking tamsulosin two days consecutively once a week (my own idea), to wash out any potential stones. I am not sure if I will continue with this, but it does increase the flow for those two days a week. After three years of this odyssey, I can never be sure of the long-term prognosis so I am really just taking it a day at a time.
Well, that is my story. Your comments are welcome..